Focal Epithelial Hyperplasia in Adult Patients With HIV Infection: Clearance With Topical Imiquimod.

Case 1 A 41-year-old man with human immunodeficiency virus (HIV) 1 diagnosed 16 years prior to his consultation was referred for an 8-month history of multiple painless lumps in his mouth. He had A2 status (CD4 cell count of 273 cells/mm3 and viral load of 43,000 copies/L) and was taking treatment with lamivudine/zidovudine (combivir) and efavirenz. Physical examination showed multiple small mucosal-colored and lobulated papulonodules located in the palate and lower gingiva and a whitish verrucous plaque on the lower labial mucosa (Figure 1a). The lesions were diagnosed clinically as focal epithelial hyperplasia (FEH) and further confirmed by classical histopathological findings (Figure 1b). He had previously received unspecified treatment; thus, topical 5% imiquimod cream was initiated every night. Mild erosion and ulceration developed in the upper labial mucosa, which were managed with lubrication (petrolatum ointment). After 2 weeks, all of the small lesions disappeared and the largest plaque resolved 1 week later (Figure 1c). A small residual mass in the area of biopsy, suggesting a scar, remained on the lower lip. The area was removed surgically and corresponded to fibrosis histologically, with no evidence of human papillomavirus (HPV) infection. CD4 cell count (694 cells/mm3) and viral load (<40 copies/L) did not show remarkable changes after imiquimod administration. No serious side effects were observed and the patient has remained free of disease after 1 year of follow-up.

Hypopigmented Mycosis Fungoides: Loss of Pigmentation Reflects Antitumor Immune Response in Young Patients.

Hypopigmented mycosis fungoides (HMF) is a form of cutaneous T-cell lymphoma (CTCL), a heterogeneous group of extranodal non-Hodgkin's lymphomas. HMF has a unique set of defining features that include light colored to achromic lesions, a predilection for darker skin phototypes, an early onset of disease, and predominance of CD8+ T-cells, among others. In the current review, we detail the known pathways of molecular pathogenesis for this lymphoma and posit that an active Th1/cytotoxic antitumor immune response in part explains why this variant is primarily seen in children/adolescents and young adults, who do not exhibit signs of immunosenescence. As a result of this potent cytotoxic response, HMF patients experience mostly favorable overall prognosis, while hypopigmentation may in fact represent a useful surrogate marker of cytotoxic immunity targeting the malignant cells. Understanding the molecular processes behind the specific features that define HMF may lead to improved diagnostic accuracy, personalized prognosis by risk stratification, and improved management of HMF. Moreover, improving our knowledge of HMF may aid our further understanding of other cutaneous lymphomas.

[Dermatophytosis due to Trichophyton rubrum. Ten-year period (1996-2006) data collection in a Dermatology Department in Mexico City]. / Dermatofitosis por Trichophyton rubrum. Experiencia de 10 años (1996-2005) en un servicio de dermatología de un hospital general de la Ciudad de México.

Dermatophytosis is the most common mycosis in the world up to 80% caused by Trichophyton rubrum. The aim of the present study was to describe the clinical characteristics of the dermatophytosis caused by T. rubrum in a dermatological outpatient clinic during a ten years period, from 1996 to 2005. We collected the data from patients with a dermatophytosis from which we have isolated T. rubrum. A total of 776 patients with dermatophytosis caused by T. rubrum were found. A slight predominance of female patients (56.2%) was observed. The most commonly affected age group was those in the third to the fifth decade of life, and house working women (33.5%) were predominant. Onychomycosis was found in 63% of the cases, tinea pedis in 22.7%, tinea corporis in 5.2% and tinea cruris in 2.8%. In onychomycosis, the first toe nail was the most commonly affected (58.9%) and the dystrophic type was seen in 50.7% of them.

Oral and Cutaneous Lymphomas other than Mycosis Fungoides and Sézary Syndrome in a Mexican Cohort: Recategorization and Evaluation of International Geographical Disparities.

BACKGROUND: Nonmycosis fungoides/Sézary syndrome (non-MF/SS) primary cutaneous lymphomas (PCL) are currently categorized under the 2005-World Health Organization/European Organization for Research and Treatment of Cancer (WHO-EORTC) classification for PCL. These differ in behavior from secondary cutaneous lymphomas (SCL) and to lymphomas limited to the oral cavity (primary oral lymphomas [POL]) both categorized under the 2016-WHO classification for lymphoid neoplasms. AIMS: This study aims to report the first series of non-MF/SS PCL, SCL, and POL in a Mexican cohort, examine the applicability of current classification systems and compare our findings with those from foreign cohorts. MATERIALS AND METHODS: Eighteen non-MF/SS PCL, four SCL, and two POL with available tissue for morphology and immunophenotypic assessment were reclassified according to the 2005-WHO/EORTC and 2016-WHO classifications. RESULTS: Non-MF/SS PCLs were primarily of T-cell origin (61%) where CD30+ lymphoproliferative disorders predominated, followed by Epstein-Barr virus-induced lymphomas, and peripheral T-cell lymphomas, not otherwise specified. Primary cutaneous B-cell lymphomas (BCL) were primarily of follicle center cell origin followed by postgerminal lymphomas of the diffuse large BCL variety. CONCLUSIONS: Most non-MF/SS PCL, SCL, and POL can be adequately categorized according to the 2005-WHO/EORTC and 2016-WHO classification systems, even when dealing with clinically atypical cases. The relative frequencies in our cohort hold closer similarities to Asian registries than from those of Europe/USA, supporting the concept of individual and/or racial susceptibility, and the notion of geographical variances in the rate of lymphomas. In particular, such disparity may arise from viral-induced lymphomas which might show partial geographical restriction.

Epidemiology of adverse cutaneous drug reactions. A prospective study in hospitalized patients.

BACKGROUND: Drug reactions are commonly present in the skin; however, their frequency in our setting is unknown. METHODS: A 10-month prospective cohort study including all hospitalized patients was designed. Those with adverse cutaneous drug reactions (ACDR) were clinically identified. RESULTS: Thirty five drug reactions (prevalence of 0.7%) were seen among 4785 (2713 females, 2072 males) discharged patients. According to Begaud's imputability criteria, the reactions were most likely attributed to a drug in 4.87%, likely in 41.46% and possible in 53.65%. The most commonly seen dermatoses were morbilliform rash 51.2%, urticaria 12.2% and erythema multiforme 4.9%. Drugs most frequently associated with ACDR were amoxicillin clavulanate (8), amphotericin B (2) and metamizole (4). Expressed as risk by 1000 day-doses (Dd: the risk a patient has of developing an ACDR after receiving 1 day of treatment with the drug): amoxicillin clavulanate Dd 7.7, amphotericin B Dd 4.8 and metamizole Dd 3.7. Immunosuppressed patients were most frequently affected. Notably, patients with systemic lupus erythematosus (SLE) had a 4.68 higher risk (CI 95% 1.794-12.186 p <0.001) of developing an ACDR. AIDS patients showed a risk of 8.68 (CI 95% 2.18-33.19 p <0.001). Non-Hodgkin's lymphoma patients also had an increased risk of developing an ACDR. Six of the 35 identified cases were patients who had been hospitalized due to a severe drug reaction (1.3/1000 patients); one died from complications directly related to the ACDR, representing a 16.6% mortality rate among those admitted for an ACDR and 0.02% among the global mortality. CONCLUSIONS: We have a low prevalence of drug reactions compared to data reported in the literature. Pharmacovigilance with special attention to immunosuppressed SLE or AIDS patients is stressed.

[Oral squamous cell carcinoma and lichen planus vs. lichenoid lesions. Case report]. / Carcinoma escamocelular y liquen plano frente a lesiones liquenoides en boca. Reporte de caso.

BACKGROUND: The development of squamous cell carcinoma from oral lichen planus is controversial. We report a case of intraoral squamous cell carcinoma, which presents together with lesions of oral lichen planus. The aim of this report was to analyze the problem to distinguish between the incipient changes of squamous cell carcinoma from the features described in oral lichen planus, in order to establish an accurate diagnosis of both entities. CLINICAL CASE: A 57-year old man with a history of smoking and chronic alcohol intake, who had an ulcerated tumor mass located in the tongue, and bilateral white reticular patches on buccal mucosa and borders of the tongue. The histopathological report was moderately differentiated invasive squamous cell carcinoma and lichen planus respectively. CONCLUSIONS: The premalignant nature of OLP is still indeterminate and controversial, this is primarily due to inconsistency in the clinical and histological diagnostic criteria used to differentiate cases of oral lichen planus from lichenoid reactions or other lesions causing intraepithelial dysplasia with high potentially malignant transformation. Oral lichenoid reactions are possibly most likely to develop malignant transformation as compared to the classic OLP lesions.

Introducción: el desarrollo de carcinoma escamocelular a partir del liquen plano bucal es controversial. Describimos un caso con carcinoma escamocelular intrabucal, que cursa con lesiones de liquen plano bucal y se analizan las dificultades para distinguir los cambios incipientes del carcinoma escamocelular de las lesiones por liquen plano intrabucales que lleven a establecer un diagnóstico certero de ambas entidades. Caso clínico: hombre de 57 años, con antecedente de tabaquismo y hábito alcohólico crónico, que presenta lesión tumoral ulcerada en borde lateral izquierdo de lengua y placas blancas reticulares bilaterales en mucosa yugal, bordes laterales y vientre de lengua. El reporte histopatológico fue de carcinoma escamocelular invasor moderadamente diferenciado y liquen plano respectivamente. Conclusiones: la naturaleza premaligna del liquen plano bucal es controvertida, esto por inconsistencia en los criterios diagnóstico clínicos e histológicos que permitan diferenciar los casos de liquen plano bucal de otras lesiones como las reacciones liquenoides o displasias intraepiteliales con alto potencial de malignización. Posiblemente las reacciones liquenoides bucales tienen un mayor riesgo de transformación maligna al compararse con el clásico liquen plano bucal.

Recalcitrant oral squamous cell papilloma lesions in two HIV-infected patients successfully treated with topical imiquimod.

BACKGROUND: Squamous cell papilloma is a benign mucosal disease associated with human papillomavirus. Its presence in human immunodeficiency virus (HIV)-infected patients has rarely been reported. Therapeutic modalities for oral squamous cell papilloma have limited success and recurrences are frequent in HIV-infected subjects. Imiquimod, is a topical immunomodulator successfully used in some human papillomavirus-related oral lesions. However, its use for oral squamous cell papillomas in HIV-infected individuals has never been described. OBSERVATIONS: We report two male adult patients with HIV-infection, B2 and C3 stage respectively, undergoing antiretroviral therapy, with multiple recalcitrant oral squamous cell papillomas, predominantly affecting the masticatory mucosa. These lesions were successfully treated with daily topical imiquimod 5% cream for a few weeks, with only mild and well-tolerated side effects. No recurrences were observed after a follow-up period of over 20 months. CONCLUSIONS: Our cases highlight the value of imiquimod for the non-invasive treatment of multiple persistent oral squamous cell papillomas in two HIV-infected patients.

[Prevalence of chronic pruritus in patients of a tertiary care hospital]. / Prevalencia del prurito crónico en pacientes de un hospital de tercer nivel.

BACKGROUND: Chronic pruritus is occasionally intractable; it has different etiologies and affects life quality. Our objective was to describe the prevalence of pruritus in newly-arrived patients at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". METHODS: A cross-sectional study was developed in newly-arrived patients. We conducted previous surveys in order to identify those patients with pruritus. With a second survey we inquired their sociodemographic traits, comorbidities, drugs being administered, the characteristics of pruritus, and the impact on the patient's quality of life. RESULTS: Of 554 previous surveys, we identified 70 cases of chronic pruritus. Most of the cases were women in their middle ages (42 years). According to the classification of pruritus, 67.2 % was associated to the underlying disease, 14.8 % was related to dermatologic condition, 3.3 % to pharmacological effects, 4.9 % to other conditions, and 9.8 % was idiopathic. Life quality was not affected in 7 %, was minimally affected in 28 %, and was mild to severe in 26 %. CONCLUSIONS: Chronic pruritus was highly prevalent in the Institute. It was mainly associated with the underlying disease, and affected significantly the quality of life. More studies are needed for better understanding its pathophisiology. Furthermore, new treatments will be available to control pruritus, bringing a better quality to those affected patients.

INTRODUCCIÓN: en ocasiones, el prurito crónico es intratable y afecta la calidad de vida. El objetivo de esta investigación fue describir la prevalencia de prurito en pacientes que acudieron a consulta por primera vez al Instituto Nacional de Nutrición y Ciencias Médicas "Salvador Zubirán". MÉTODOS: estudio observacional y transversal. Se realizaron pre-encuestas a pacientes de nuevo ingreso, para identificar a quienes tenían prurito. Se investigaron características sociodemográficas, comorbilidades, fármacos de base, características del prurito y el impacto que tenía en la calidad de vida. RESULTADOS: Se realizaron 554 pre-encuestas, en las cuales se identificaron 70 casos (11 %). El prurito crónico predominó en mujeres; la edad promedio fue de 42 años. Según la clasificación del prurito, 67.2 % estaba relacionado con la enfermedad de base, 14.8 % con enfermedad dermatológica, 3.3 %, con fármacos, 9.8 % era idiopático y 4.9 % se debía a otros motivos. La calidad de vida no se afectó en 7 %, en 28 % los efectos fueron mínimos y en 26 %, de intensidad moderada a severa. CONCLUSIONES: el prurito crónico fue altamente prevalente en el Instituto, se relacionó principalmente con la enfermedad de base y afectó significativamente la calidad de vida. Con el estudio de este padecimiento se dilucidará su etiopatogenia y los tratamientos que permitan controlarlo y brindar mejor calidad de vida de los pacientes afectados.